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TEDx Talks
Published: 2016-12-20
Source: https://www.youtube.com/watch?v=LjqsGfAU42o
going to talk today about position held or position Madison the power of position how that's going to change medical care how that's going to change our health system and disrupt everything we currently do for better what is precision health well now that we have the technology to actually synthesized large amounts of data we can actually create individualized data sets for any given person that includes everything
about them all the way from their genetic code that they were born with to the biological she'd just have occurred in their body threw down government through our childhood through environmental exposures and their behavior patterns do they smoke do they not smoke do they eat healthy do the exercise all of these behaviors spatter because that impacts a person's biology that impacts a person's genetic material in
a permanent way that results in held or disease and that's the concept of precision help how is that going to disrupt our health care well it's going to disrupt our health care in a number of ways but some of the major things that will happen over the next few years is that we're going to be able to treat diseases like cancer that previously were not treatable
or previously were uniformly fatal how's that going to happen with precision medicine what is cancer simply it's a dramatic malformation in the cells code that determines how the cells divide and how the cells integrate themselves into the rest of the body as we all know most of our organs are constantly generating new cells old cells are dying off new seltzer replacing them like everything on ads
in this world is constant a news replacing the old and that normally happens in a very systematic way there are hundreds of genes that regulate that process and the process involves clearly as the cells are getting older they go to a gradual that and the new cells take their place and appropriately arrange themselves with the rest of the organ well unfortunately in certain situations that genetic
code gets messed up so the cells that are born with these master of genetic code don't take instructions correctly so they start growing uncontrollably they start cannibalizing cells next to them they have no turnoff signals within them so number of such malformations suddenly make them start growing out of control and that's what you see the cells are abnormal normally if there's an abnormality in those cells
they go to a natural death process but that doesn't happen in cancer so when this happens then cancer cells grow uncontrollably tumors happen and the person eventually fails to survive the Serb onslaught of pathological selves so how does precision medicine going to change that well right now we can do a lot more with the technology and the data that we can collect and synthesize and prove
variety of mechanisms genomic medicine is one of those where we can actually look at the entire genetic code off the Celts see what kind of mistakes there are and then tried to correct them or try to target them let me illustrate this with the case of alma Emma is a six year old girl as you can see bright eyed beautiful girl going to school normal child
certainly starts complaining of stomach aches with them two months she starts to lose weight so she's brought to Riley hospital and turns out with variety of testing I find that she has a very aggressive form of ovarian cancer so good through this this kind of disease is extremely aggressive she's just a child and ovaries don't double up cancer at that age unless there's some sense serious
spelled difference so she goes through traditional chemotherapy absolutely no effect and you see in this cat scan that there are tumors everywhere in her body spreading aggressively so where telling her parents Emma probably won't live BR none of the six weeks at this point what do I have to do he said let's let's go ahead get her genome sequencing con what does that mean it just
means that we are reading the entire genetic code off this tumor cells so her tumor tissue was send for whole genome sequencing which is not a trivial task you can imagine it's literally reading every alphabet in her genetic code in the cell's genetic code Mr give you a concept of what that means %HESITATION this Moby Dick the famous novel we all know about it has about
two hundred and three thousand words in it little over one point five million alphabets the human genome has three billion base pairs or three billion alphabets and so if I were to tell someone find two letters that are misplaced in this entire copy of Moby Dick it's going to take because weeks figure out which one it is so imagine the book with three billion alphabets and
you have to find a spelling mistake somewhere in that book and that's what whole genome sequencing does well we do have the technology now to do that when the home human genome was sequenced completely and the data was finally available in two thousand three it took nearly twelve years almost twenty seven billion dollars to sequence the first Dino today we can do it in four days
four twenty seven hundred dollars so it it's going to be probably done in less than a thousand dollars in a couple of years so this going to totally change the way we are looking at the seasons where we are looking at how to treat individual patients so how did this help Emma we did that with her humor turns out she had one aggressive mutation it's called
a L. K. R. ACOG mutation which is normally seen in older people who celebrate rare form of lung cancer so she had this unique mutation in her overly that caused this cancer fortunately we have a drug that works against this particular mutation usually it's currently approved for lung cancer never been used in children never been used for ovarian cancer while we had nothing to lose right
with Emma so we started her on that within four weeks her cancer started to disappear within three months I'm pleased you're gone am I went to Disney world I'm sorry I still get choked up every time to tell her story amber was the lucky one because we already had a drug that would address this mutation not all children are this lucky not all cancer patients are
this lucky at but the technology is moving so fast lots of wonderful things are happening in biology today we have another way to approach this instead of simply drugs depending on drugs which take years to develop one of those revolutionary technologies is immunotherapy so it's another technology that we're beginning to build that I you what is that what this does is in addition to the genetic
code we can actually look at the proteins that are on the cells so we can profile the Celts and then target the immune system to attack those cells we can engineer a person's immune system let me illustrate this quickly with another story this is a story of Josh Josh again currently eleven year old boy at age five he came to Riley with acute lymphoblastic leukemia Carmen
leukemia that occurs in children Josh went through chemotherapy and radiation ninety five percent cure rate for this generally so Josh responded nicely I said great follow you up if you're free of disease for five years a key and you're good you're one of the lucky ones we think that happens in ninety five percent of the cases Josh was going along fine literally for years to the
day the disease comes back so he is one of the unlucky five percent didn't have that response so what we were able to do then typical approach right now is a bone marrow transplant which sometimes to take out the entire bone marrow and replace it with the new bone marrow stream Lee difficult to spur painful procedure months in the hospital so Josh went through that god
clear deficit leukemia two years disease free the age eleven the disease comes roaring back so we are out of all options turns out that Josh's lymphoma cells have a protein on them called CD nineteen a common protein that occurs in the PBS on lymphomas Sir weaver able to tape Josh's immune cells call T. cells introducing new gene into the cells through a virus and now several
of his T. cells our program to go kill any cell that has these proteins CD nineteen Dave fact within two months the cells have been group replicating in his body completely killing all the cancer cells what's more important is that these cells will be me his body for the rest of his life they'll be circulating they'll be watching for these cancer cells to pop up anywhere
they're going to kill them so it's almost like a permanent chemotherapy that's constantly waiting the cancer still appear so that's the power of precision medicine that's going to change the way we think about the seasons change the way we think about how and how we can manage our own bodies better so with the are you proposal on the grand challenge what are hopeless that will actually
cure some diseases temporarily want to cure cancer want to cure taste one childhood disease beyond cancer this approach is going to change many other diseases I think after cancer the next disease to fall will be Alzheimer's because that's also prime for all of these technologies we can predict who might become demented we can predict what biological pathways may cause a dimension and we can literally change
the course of the disease over the next ten years but beyond that we are also a whole create a new generation of scientists a new generation of education programs that would make us prepared for this kind of revolution in healthcare so the power of precision medicine is going to totally disrupt and transform the way we think about healthcare diseases treatments and the way we take care
